lately revised guidelines have sugg...

lately revised guidelines have suggested that the interval between cervical cancer screening touchstones might be lengthened to three years in women with previously normal Papanicolaou (Pap) smears and no increased risk factors for cervical cancer. This shift from the longstanding recommendation for annual Pap ordeals was caused by a lack of evidence that of frequent occurrence screening in low-risk women provided any additional protection against cervical cancer. Sawaya and colleagues, with the Center for Disease direction and Prevention (CDC), examined nationwide cervical cancer screening data to quantify the relative risks associated with les visit often screening.

The authors analyzed data from a somewhat higher risk population of low-income, underinsured women who received cervical cancer screening between the walls of a nationwide program administered from the CDC. Approximately one half of the participants were from minority form into groupss and more than one half were older than 45 years. A total of 1174727 screening touchstones were reviewed. The authors exclud 19784 touchstones (1.7 percent) that had unsatisfactory technique or unclear cytology inferences If Pap tests from any participants were performed more many times than every nine months, they were considered likely to exhibit surveillance of a known abnormality rather than simple screening, and they were exclud Cytology ensues were reported using the 1991 Bethesda body categories.

Biopsy-proven dysplasia occurr in the greatest degree frequently in women younger than 30 years. Cervical cancer was rare overall, and almost all cases of cancer occurr in women with no history of screening (002 to 006 percent incidence across age groups) No cases of invasive cervical cancer occurr in women who had at least three previously normal Pap ordeals Using mathematical models, the authors calculated the extra risk of cervical cancer that would arise if women with three consecutive normal screening trials extended the interval between Pap criterions to three years, instead of common year. The increased incidence of cancer was approximately three cases by means of 100,000 women between 30 and 64 years of age. For comparison, the authors noted that this increase was about equable with the risk of breast cancer among men 45 to 64 years of age.

The authors end that annual cervical cancer screening in women with three previously normal Pap smears provides a negligible benefit, and that the screening interval may be reach outed safely to every three years in this low-risk group

Sawaya GF et al. Risk of cervical cancer associated with extending the interval between cervical-cancer screenings. N Engl J M October 16 2003;349:1501-9

EDITOR'S NOTE: smooth in the higher risk population of low-income, underinsured women cervical cancer occurr almost exclusively in patients with no previous Pap testing. To best remodel the suffering from cervical cancer, physicians ne to direct their efforts toward reaching women who have not at all been screened, rather than repeat millions of annual Pap smears in low-risk patients who derive no benefit, nevertheless endure some inconvenience and cost from frequent testing.--B.Z.

COPYRIGHT 2004 American Academy of Family Physicians

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